Project: EDM (Encounter Data Management) Business Rules Configuration

 EDM- is widely used healthcare claim submission system in US. It is used to submit Medicare and Medicaid claims to CMS (Centers of Medicare and Medicaid Services) i.e. to US Government.

 Technology Used: EDI, Facets, DMS, QNXT, MS Excel, SQL Server 2008.

 Role: Data Analyst

Responsibilities:

 Analyze, compile and validate crucial medical data in the form of Medicare and Medicaid claims.

 Identify problems in 837 formatted data, and provide solution for the same.

 Identify problems in claim processing application like Facets, QNXT.

 Writing SQL queries on backend data and discuss issues with development team, if any.

 Used DML,DDL,DCL,TCL commands, All Sql Function.

 To resolve issues on the claims, consult with respective department like BMS claims, BMS enrollment, Provider maintenance, EDM legacy (Development team).

 Resubmit the resolved claims to CMS.

 Extracting data from Database Tables as per the requirement & various conditions.

UNIX:-

 Performing Weekend maintenance activities as per the instructions.

 Space management.

 Creating files & directories.

 Checking files & directory permissions.

Project: Mobile Operator (Tele Communication)

Roles and Responsibilities

 Discuss the queries with customer.

 Check application status active/De-active

 If applicable then refund the amount to customer

 Send the daily and weekly report to the seniors

 Project: Highmark

 Highmark is an insurance company base in U.S.A. it also called as Stellar.

Roles and Responsibilities

 Discuss the queries with customer.

 Check application status active/De-active

 Generate Tickets for back end team

 Check application status.

 Managing daily and weekly report and send to the seniors

• Performing Weekend maintenance activities as per the instructions.
• Space management.
• Creating files & directories.
• Checking files & directory permissions.

EDM- is widely used healthcare claim submission system in US. It is used to submit Medicare and Medicaid claims to CMS (Centers of Medicare and Medicaid Services) i.e. to US Government.